POS0924 THE ROLE OF RAYNAUD’S PHENOMENON ON MATERNAL AND FETAL OBSTETRICAL OUTCOMES
Authors: E. Bellis, V. Codullo, B. L. Palermo, F. Bottazzi, A. Biglia, C. Bellingeri, F. Beneventi, A. Spinillo, C. Montecucco, G. Zanframundo, L. Cavagna
Journal: Annals of the Rheumatic Diseases (2022)

Background It is established that Raynaud’s phenomenon (RP) may influence pregnancy outcomes when secondary to rheumatic conditions (1,2). Data on the impact of primary RP (pRP) on pregnancy are very limited. Objectives To retrospectively evaluate the impact of pRP on pregnancy outcomes. Methods Women with pRP were included in the study. They were compared with a group of women affected by UCTD with RP, and by UCTD without RP. These women were assessed and followed at our outpatient clinic from January 2011 to October 2020 and they did not exhibit an evolution to a UCTD or to a definite CTD during at least one-year follow-up. Antiphospholipid antibody positivity, twin pregnancies and voluntary termination of pregnancy were exclusion criteria. Women with pRP were also compared with a group of healthy pregnant women enrolled by our gynaecologist during the first trimester of pregnancy. Maternal and foetal outcomes were retrospectively recorded. ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi2 test or the Fischer exact test for categorical were performed (level of significance. P&lt;0.050). In the post-hoc analysis we used the Mann-Whitney test (quantitative variables) or with the Chi2 test/Fischer exact test (qualitative variables), applying the Bonferroni correction with pRP women as a reference group (level of significance: p&lt;0.0167). Results The analysis included 188 women with a total of 375 pregnancies divided in 4 groups: -Group “pRP”: 46 women with RP without secondary causes, and a total of 106 pregnancies (reference group), -Group “RP-UCTD”: 48 UCTD women with RP and a total of 88 pregnancies, -Group “UCTD”: 37 UCTD women without RP and a total of 88 pregnancies, -Group “HC”: 57 healthy women with a total of 93 pregnancies. The reference group did not differ from the others regarding age at conception. Prophylactic acetylsalicylic acid was administered during pregnancy to 9% of patients with pRP compared to 1% in HC (p=0.010). In contrast, in the RP-UCTD this percentage was significantly higher (32%, p&lt;0,001) than in pRP. pRP group showed an increased rate of 1st trimester miscarriages (33% vs 16%, p=0.006, OR 2.05 and 95%CI 1.05-3.98), a lower median birth weights (3038 g vs 3358 g, p=0.002), a higher rate of infants with a birth weight &lt;10th percentile (21% vs 3%, p=&lt;0.001, OR 8.36 and 95% CI 1.85 - 37.84) with respect to HC. There was no statistically significant difference between the reference and the UCTD groups. No statistically significant differences were observed when considering obstetrical outcomes (eg: mode of delivery, median gestation duration, gestational diabetes mellitus, hypertensive disorder of pregnancy, premature rupture of membranes, oligo-anhydramnios). Conclusion Our study shows that pRP in a retrospective cohort has an impact on pregnancy outcomes, with significantly more miscarriages and lower birth weight infants compared to HC. Importantly, pregnancy outcome in pRP women did not differ with respect to UCTD with and without RP, conditions generally associated to maternal morbidity, but in the RP-UCTD group prophylactic acetylsalicylic acid was more commonly prescribed. Further prospective studies aiming at evaluating these differences and at identifying the appropriate follow-up and the possible benefit from the use of prophylactic acetylsalicylic acid during pregnancy in RP are necessary. References [1]Liu E et al. Arch Rheumatol., 2017. [2]Al Arfaj A et al. Lupus. 2010. Table 1. Analysis of obstetrical outcomes Primary RP (pRP ) RP-UCTD UCTD HC p-value Miscarriages N. (% ) 35 (33%) 17 (19%) 30 (31%) 15 (16%) p=0,017 vs pRP reference p=0,051 p=0,750 p=0,006 Median weight at birth (IQR), gr 3038 (2710-3500) 3180 (2935 - 3465) 3157 (2910 - 3610) 3358 (3195 - 3583) p=0,02 vs pRP reference p=0,3473 p=0,1542 p=0,0002 Birthweight &lt; 10th percentile N. (% ) 15 (21%) 7 (10%) 5 (8%) 2 (3%) p=0,002 vs pRP reference p=0,087 p=0,03 p=&lt;0,001 Disclosure of Interests None declared